Benjamin S. Wessler

Zhe Huang, Mary-Joy Sidhom, Benjamin S. Wessler et al.

Semi-supervised learning (SSL) promises improved accuracy compared to training classifiers on small labeled datasets by also training on many unlabeled images. In real applications like medical imaging, unlabeled data will be collected for expediency and thus uncurated: possibly different from the labeled set in classes or features. Unfortunately, modern deep SSL often makes accuracy worse when given uncurated unlabeled data. Recent complex remedies try to detect out-of-distribution unlabeled images and then discard or downweight them. Instead, we introduce Fix-A-Step, a simpler procedure that views all uncurated unlabeled images as potentially helpful. Our first insight is that even uncurated images can yield useful augmentations of labeled data. Second, we modify gradient descent updates to prevent optimizing a multi-task SSL loss from hurting labeled-set accuracy. Fix-A-Step can repair many common deep SSL methods, improving accuracy on CIFAR benchmarks across all tested methods and levels of artificial class mismatch. On a new medical SSL benchmark called Heart2Heart, Fix-A-Step can learn from 353,500 truly uncurated ultrasound images to deliver gains that generalize across hospitals.

Cynthia Feeney, Shane Williams, Benjamin S. Wessler et al.

Echocardiogram datasets enable training deep learning models to automate interpretation of cardiac ultrasound, thereby expanding access to accurate readings of diagnostically-useful images. However, the gender, sex, race, and ethnicity of the patients in these datasets are underreported and subgroup-specific predictive performance is unevaluated. These reporting deficiencies raise concerns about subgroup validity that must be studied and addressed before model deployment. In this paper, we show that current open echocardiogram datasets are unable to assuage subgroup validity concerns. We improve sociodemographic reporting for two datasets: TMED-2 and MIMIC-IV-ECHO. Analysis of six open datasets reveals no consideration of gender-diverse patients and insufficient patient counts for many racial and ethnic groups. We further perform an exploratory subgroup analysis of two published aortic stenosis detection models on TMED-2. We find insufficient evidence for subgroup validity for sex, racial, and ethnic subgroups. Our findings highlight that more data for underrepresented subgroups, improved demographic reporting, and subgroup-focused analyses are needed to prove subgroup validity in future work.

Zhe Huang, Xiaowei Yu, Benjamin S. Wessler et al.

Automated interpretation of ultrasound imaging of the heart (echocardiograms) could improve the detection and treatment of aortic stenosis (AS), a deadly heart disease. However, existing deep learning pipelines for assessing AS from echocardiograms have two key limitations. First, most methods rely on limited 2D cineloops, thereby ignoring widely available Doppler imaging that contains important complementary information about pressure gradients and blood flow abnormalities associated with AS. Second, obtaining labeled data is difficult. There are often far more unlabeled echocardiogram recordings available, but these remain underutilized by existing methods. To overcome these limitations, we introduce Semi-supervised Multimodal Multiple-Instance Learning (SMMIL), a new deep learning framework for automatic interpretation for structural heart diseases like AS. When deployed, SMMIL can combine information from two input modalities, spectral Dopplers and 2D cineloops, to produce a study-level AS diagnosis. During training, SMMIL can combine a smaller labeled set and an abundant unlabeled set of both modalities to improve its classifier. Experiments demonstrate that SMMIL outperforms recent alternatives at 3-level AS severity classification as well as several clinically relevant AS detection tasks.

Zhe Huang, Benjamin S. Wessler, Michael C. Hughes

Aortic stenosis (AS) is a degenerative valve condition that causes substantial morbidity and mortality. This condition is under-diagnosed and under-treated. In clinical practice, AS is diagnosed with expert review of transthoracic echocardiography, which produces dozens of ultrasound images of the heart. Only some of these views show the aortic valve. To automate screening for AS, deep networks must learn to mimic a human expert's ability to identify views of the aortic valve then aggregate across these relevant images to produce a study-level diagnosis. We find previous approaches to AS detection yield insufficient accuracy due to relying on inflexible averages across images. We further find that off-the-shelf attention-based multiple instance learning (MIL) performs poorly. We contribute a new end-to-end MIL approach with two key methodological innovations. First, a supervised attention technique guides the learned attention mechanism to favor relevant views. Second, a novel self-supervised pretraining strategy applies contrastive learning on the representation of the whole study instead of individual images as commonly done in prior literature. Experiments on an open-access dataset and an external validation set show that our approach yields higher accuracy while reducing model size.